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1`a ' <br />RECEIVED <br />NOV 1 Q ZUiL <br />DIVISit, ,,, -:: ,'t - ,,.,MATION, <br />MI1 I_NC & SAFETY - MINERALS <br />FEE ARPORT MAP SND; <br />AA) /V D <br />Montezuma County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1978107 <br />111111111 <br />27673 msr 1 4300 -MAFO I Minerals Annual Fees <br />M1978 -107 <br />Receipt #: <br />Date: <br />Permit: <br />18569 <br />11/19/2014 <br />M1978107 <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1 <br />